Healthcare Provider Details

I. General information

NPI: 1518528413
Provider Name (Legal Business Name): DR RAM DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 06/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 MISSION AVE
OCEANSIDE CA
92058-7106
US

IV. Provider business mailing address

11838 GLENHOPE RD
SAN DIEGO CA
92128-5002
US

V. Phone/Fax

Practice location:
  • Phone: 858-987-2165
  • Fax:
Mailing address:
  • Phone: 858-987-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEGGY KARGAR RAM
Title or Position: OWNER
Credential: DDS
Phone: 858-987-2165